Ovulation is what happens when an egg is released from one of the ovaries. This usual y happens once every month in women between the ages of approximately 13 and 50 years, except when she is pregnant or taking 'the pil '. In some women, this does not happen regularly. Some may ovulate once every 6 or 8 weeks; others once every few months and others once a year, or perhaps never unless they are given some treatment to stimulate the ovaries. It is also quite common for women who have regular periods to have one or two cycles a year in which they do not ovulate. Ovulation Induction

Treatment that may be used to stimulate the ovary when ovulation is not occurring regularly includes tablets or injections. The tablets are a drug cal ed clomiphene citrate (brand names are Clomid or Serophene). These are taken once daily for 5 days, usual y commencing on the second day of menstrual bleeding, and they stimulate the ovaries indirectly. In some women, Metformin (brand names are Diabex, Diaformin, Glucophage, Glucomet, Glucohexal), may also be used to increase the chance that ovulation wil occur. Metformin is a drug commonly used in the treatment of diabetes. It can also be used in cases of insulin resistance, which can occur in women with irregular cycles, and also when women have Polycystic Ovarian Syndrome (PCOS). Metformin may be used with clomiphene to increase the effect of the clomiphene. Both of these drugs may have side effects that your doctor wil discuss with you. The injections are of the hormones cal ed gonadotrophins that stimulate the ovaries directly. There are two types of gonadotrophins – r-FSH (brand names Gonal F or Puregon) and r-HCG brand name Ovidrel. Either Gonal F or Puregon injections are given under the skin of the abdomen once a day, usual y for 10 days or more to stimulate the ovaries into growing egg fol icles. The number of tablets of clomiphene citrate or ampoules of FSH given by injection, required to stimulate the growth of an ovarian fol icle (a cyst containing an egg) varies widely between women. Each treatment is individualised and in some cycles, progesterone or HCG may be given for a number of days after ovulation until the outcome of the cycle is known. The injections can be given either at Westmead Fertility Centre, or by you or your partner, whichever you prefer and find convenient. You wil need to come to the Fertility Centre a number of times during a cycle of treatment to have blood tests and ultrasound scans. The results of these are used to adjust the dose of tablets or injections and therefore reduce the risk of having a multiple pregnancy or of suffering the effects of excessive stimulation. Ovidrel is used to trigger ovulation once the gonadotrophin injections have stimulated one or more eggs to become mature. Ovidrel is usual y given only once in each monthly cycle by an injection under the skin of the abdomen.
__________________________________________________________________________________________
Department of Reproductive Medicine, Westmead Hospital
Dr H Smith; Dr N Gayer; Dr D Lok; Dr L Melhem; Dr T Hng; Dr S Soo; Dr A Tong
Westmead Fertility Centre

These treatments, both the tablets and in particular the injections, may cause many eggs to grow at the one time and therefore have a risk of causing multiple pregnancy. These treatments are also associated with a risk of causing other symptoms such as abdominal bloating and fluid retention as wel as lower abdominal pain. These are al part of the ovarian hyperstimulation syndrome. Multiple pregnancy. Although we strive to avoid this by careful cycle monitoring, the risk of multiple births (i.e. twins or greater) is stil increased by this treatment. Ovarian hyperstimulation syndrome (OHSS). This is a condition where many fol icles grow on the ovaries causing them to become larger than normal and to secrete large amounts of fluid. This may cause severe abdominal swel ing. Because low doses of drug are used in this treatment program, OHSS is an uncommon side-effect. The number of tablets of clomiphene citrate or ampoules of FSH given by injection, required to stimulate the growth of an ovarian fol icle (a cyst containing an egg) varies widely between women. Each treatment is individualised and in some cycles, progesterone or HCG may be given for a number of days after ovulation until the outcome of the cycle is known. The injections can be given either at Westmead Fertility Centre, or by you or your partner, whichever you prefer and find convenient. You wil need to come to the Fertility Centre a number of times during a cycle of treatment to have blood tests and ultrasound scans. The results of these are used to adjust the dose of tablets or injections and therefore reduce the risk of having a multiple pregnancy or of suffering the effects of excessive stimulation. WARNING

The fertility drugs may cause too many eggs to grow to maturity thus creating the risk of a multiple pregnancy occurring. It is therefore our policy that if more than three mature fol icles are seen on the ultrasound scan, the cycle wil be cancel ed and you wil be strongly advised to use effective contraception for the remainder of the month. The medication dose wil be reviewed before you start another cycle. Instructions regarding gonadotrophin injection treatment:

1. If you do not have regular "normal" periods, you may need to take Provera or
Primolut N for 10 days to induce a period before you can start.
2. Cal Westmead Fertility Centre (9845 7484) on day 1 of your cycle when you wish
to commence treatment. You and your partner should have had a number of tests done prior to beginning this treatment and you wil both have signed a consent form.
3. The injections commence between the 4th and 10th day after a period begins. You
wil be given an appointment to come to the Westmead Fertility Centre for a blood test, nurse interview and injection technique You wil be instructed when to return for your next blood test.
__________________________________________________________________________________________
Department of Reproductive Medicine, Westmead Hospital
Dr H Smith; Dr N Gayer; Dr D Lok; Dr L Melhem; Dr T Hng; Dr S Soo; Dr A Tong
Westmead Fertility Centre
4. You wil also need to make your payment for the treatment cycle, and be oriented
5. From then whenever you have a blood test you wil be contacted in the afternoon
and informed when you need to return for further blood tests; or if you need to change your medication dose.
6. A vaginal ultrasound scan to measure the size and number of the developing
fol icles wil be done when indicated by the blood test results. If too many fol icles develop, treatment wil be stopped and we wil recommend you use some form of contraception (eg. condoms) to avoid the risk of multiple pregnancy.
7. When the ultrasound scan and the blood test results are satisfactory, an injection
of HCG wil be given to 'trigger' ovulation. Ovulation should occur within the next 36 hours and the best time for intercourse is within 24 hours of this injection.
8. A blood test to measure progesterone is required one week after the HCG
injection to check if ovulation occurred and a blood test to confirm pregnancy is done 16 or more days after the HCG 'trigger' injection.
What are my chances of pregnancy?

Fol owing review of our statistics for ovulation induction treatment with injection over the past two years patients have a 29% chance of achieving a pregnancy for each cycle of treatment. Counselling

The nursing, scientific and medical staff are available to answer any questions and discuss any problems which may arise before, during and after treatment. A qualified counsel or is also available on request within the unit, from Tuesday to Thursday. Support group

We encourage you to join the Australian infertility support group "ACCESS". This gives you an opportunity to meet others with similar problems and to gain further knowledge about infertility treatments. The group produces a newsletter and holds meetings to discuss various infertility-related topics with guest speakers. ACCESSPhone: 1800 888 896 Web address: www.access.org.au
__________________________________________________________________________________________
Department of Reproductive Medicine, Westmead Hospital
Dr H Smith; Dr N Gayer; Dr D Lok; Dr L Melhem; Dr T Hng; Dr S Soo; Dr A Tong
Westmead Fertility Centre Suggested reading
If you feel you would like to read further, here is a short list of books we recommend. Some can be borrowed from the W.I.S.H. library, situated in our waiting room, others can be purchased from 'Health Link Westmead Hospital bookshop, or from any good bookshop.
Getting pregnant A Compassionate Resource To The Infertility Book: A Comprehensive Medical Overcoming Infertility & Emotional Guide
Celestial Arts Publishing California 1992
Why me: The Real-life Guide to Infertility Battles with the BABY GODS INFERTILITY:
Amanda Hampson Doubleday Moorebank NSW 1997
The Chance of a Lifetime: Infertility and IVF Infertility All your questions answered. When the Dream is Shattered Infertility: A Guide for the Childless Couple Healing the INFERTILE Family. IVF: In Vitro Fertilisation The Time In Between: Motherhood Grief Surviving Infertility: Compassionate Guide Through the Emotional Crisis of Infertility Baby Making: The Technology and Ethics Loss of a Baby: Understanding Maternal Grief Getting Pregnant: A Guide for the Infertile Endometriosis: An Enigma Coping With Grief When your womb is empty
Sydney. Australian Broadcasting Corp. 1995
The Infertility Handbook: A guide to making The Child Within: surviving the Shattered Dreams of Motherhood
Al en & Unwin St Leonards NSW 2003The Long-Awaited Stork: A Guide To Parenting Patient letters. Personal experiences of IVF After Infertility
__________________________________________________________________________________________

The Box-Of-Chocolate Phenonema: Using narratives to improve staff morale in large organisations Carol Ainley, Paul Bason, Carola Boehm, Mo Din, Helen Jones, Rita Lewin, Helen Presented by: Carola Boehm, Manchester Metropolitan University Abstract In 2010 a group of senior managers of the Manchester Metropolitan University, one of the largest universities in the United Kingdom with over 400

Research Plus June/July 2013 PTSD prevention A systematic review of the effectiveness and potential harm of psychological, pharmacological and emerging interventions to prevent post-traumatic stress disorder (PTSD) in adults found a general lack of robust evidence. Only interventions designed to work in the first three months after the traumatic exposure were included (19 included stud